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Diabetes prevalence growing - average treated diabetic has average blood sugar of 220 (Normal is less than 100) Despite spending over $15 Billion in cholesterol meds in 2002, only 18% at goal. Most people dont even know their goal. (Pearson TA – LTAP Arch Internal Medicine 2000;160:459-67) 1 in 3 U.S. adults are obese. Total direct & indirect costs related to obesity in the U.S. totaled $117 Billion in 2000. Asthma prevalence is increasing and death rate among asthmatic children is rising. As Costs Increase, Overall Health Declines

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The Pharmacy Benefit Process Customer Pharmacy Pharmacy benefits managers (PBM) are companies that are hired to administer drug benefit programs for employers, government agencies, and health insurance carriers. Claims Adjudication Is the member eligible? Is the drug covered? What is the co pay? Are there any interactions (DUR) PBM Transaction Engines Can Be Rented = Commodity

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Payments by Managers of Drug Plans Face Scrutiny By MILT FREUDENHEIM December 11, 2003 - The pharmacy benefit companies that manage drug coverage for most working Americans commonly offer millions of dollars in payments to important customers when contracts with them are signed, according to industry executives and consultants. The practice is receiving widespread attention after Justice Department officials on Tuesday accused Medco Health Solutions, one of the largest pharmacy benefit managers, of violating kickback laws by paying $87.4 million to Oxford Health Plans. But industry experts said such payments often added to the drug costs that pharmacy benefit managers, or PBM's, were hired to shrink. The PBMs claim that some payments are advances against future rebates from drug manufacturers that reward large purchases of certain drugs. Gerry Purcell, a consultant to health plans based in Atlanta, said one example of this was the several million dollars in a package of upfront payments the Texas Employees Retirement System collected from Medco. The kickback accusations against Medco were added by the United States attorney in Philadelphia, Patrick L. Meehan, to a broader civil complaint against Medco filed in September. The complaint linked the payments to Medco's contracts with Oxford and Blue Cross and Blue Shield plans to provide drugs to federal employees and people in government financed health care programs. The new filing also added Robert J. Blyskal, a former Medco executive vice president, as a defendant. He is accused of "conducting a coverup of intentional destruction of patient prescriptions at Medco Health's Tampa II mail-order pharmacy in 1998.''